A fee emergency

EVERETT – There is no such thing as a free ride, even to the hospital.

Due to increasing demand and a budget shortfall, the Everett Fire Department wants to start charging patients for ambulance rides. The Everett City Council at its Oct. 6 meeting will consider adding an ambulance transport fee of up to $675.

However, if the proposal passes, those who live and work in Everett will never see a bill.

The city would directly bill health insurance companies for residents, as well as nonresidents who work in the city. If a patient’s insurance doesn’t cover the entire bill, the city would pick up the remainder.

City residents without health insurance would not be charged.

“For the person who dials 911, nothing in their care (would) change,” said Ed Oas, Everett assistant fire chief.

Everett is one of the few fire service agencies in the county that doesn’t charge for ambulance service. Most bill patients hundreds of dollars.

Fire officials say the fee is necessary to continue providing emergency medical services. The city has seen rising emergency costs and calls, but tax dollars aren’t keeping pace.

“This really didn’t come to a head until declining revenue from the EMS levy,” Oas said. “That changed the whole ballgame for us.”

The proposed transport fee would bring in an estimated $2 million in 2005, he said. The city’s emergency medical services budget for this year is about $5 million.

The fire department received 14,119 medical emergency calls in 2003, up from 12,167 in 2000. The Fire Department took about 5,000 of those patients to the hospital.

Private ambulances, which charge transport fees of at least $350, took about 4,000 of those patients to the hospital when the cases weren’t life-threatening.

Without the fee, the city would be forced to dramatically cut its emergency medical services starting in 2008, said Jack Robinson, Everett deputy chief of emergency medical services.

The city said the key reason for the expected shortfall is voter-approved initiatives. Rather than raise taxes, the city opted to consider charging individual users an ambulance transport fee, city spokeswoman Kate Reardon said.

“You’re putting the cost where it’s being used instead of a broad-based tax for people who may never use” emergency services, Oas said.

That’s why other fire districts opted for the fee. Snohomish County Fire District 8 in Lake Stevens started charging up to $475 in January 2003 after voters rejected a levy increase.

“The only option we had was to pass on the cost of doing business through our transport,” said Dave Lingenfeter, interim fire chief.

In 2003, District 8 charged nearly $1 million in transport fees for its 1,905 emergency calls. The district received about 60 cents for every dollar billed due to low reimbursement rates from Medicare, Medicaid and private insurance, he said.

“We’ve spent a great deal of time and effort to maximize the amount of reimbursement,” Lingenfeter said.

While residents may not notice the difference in taxes or other fees, such cost shifting does affect health insurance costs, said Bill Ripple, a spokesman for the state insurance commissioner’s office.

Sooner or later, residents will end up paying, even if it’s their health insurance that’s charged, he said.

“Cost shifting doesn’t make the burden go away. It will add to the burden the insurance carrier’s members are going to have to pay,” he said.

Ripple added that claim costs and an increase in claims are among the factors behind rising health care costs.

“It will factor in,” he said. “To the extent that it does, who knows.”

In Marysville, the fees haven’t kept people from calling during emergencies. Marysville charges up to $425, plus mileage and supplies.

“The reality of America’s fire service is that everybody is slowly but surely headed toward broke,” said Marysville Fire District spokesman Nathan Trauernicht. “Districts that aren’t charging for EMS now will be in the next 15 to 20 years.”

Reporter Jennifer Warnick: 425-339-3429 or jwarnick@heraldnet.com.

Ambulance fees vary

Most fire districts in Snohomish County charge for taking patients to the hospital. The cost is higher if a patient is critically ill and paramedics must provide advanced life support. The ambulance essentially becomes a rolling emergency room capable of providing most of the care you’d find at a hospital.

Here’s what some fire districts charge:

Everett (proposed fee): $475 for basic life support; $675 for advanced life support. Plus $15 per mile.

District 8 (Lake Stevens): $350 for basic life support; $475 for advanced. Plus $10 per mile.

Marysville: $275 for basic life support; $375 for advanced; $425 when the patient needs extra advanced care; $500 for out-of-district calls. Plus $8 per mile.

Lynnwood: No charge.

District 1 (south Everett): $400 for basic life support; $600 for advanced.

District 7 (Clearview): $400 for basic life support; $600 for advanced. Plus $7.50 per mile.